Scolaris Content Display Scolaris Content Display

Study flow diagram.
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Figure 1

Study flow diagram.

Methodological quality graph: review authors' judgements about all methodological quality items presented as percentages across all included studies.
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Figure 2

Methodological quality graph: review authors' judgements about all methodological quality items presented as percentages across all included studies.

Methodological quality summary: review authors' judgements about all methodological quality items for each included study.
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Figure 3

Methodological quality summary: review authors' judgements about all methodological quality items for each included study.

Forest plot of comparison: 1 NEW Intrauterine insemination versus fallopian tube sperm perfusion, outcome: 1.1 Live birth per couple.
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Figure 4

Forest plot of comparison: 1 NEW Intrauterine insemination versus fallopian tube sperm perfusion, outcome: 1.1 Live birth per couple.

Forest plot of comparison: 1 IUI vs FSP: unexplained or mixed (non‐tubal) causes, outcome: 1.2 Clinical pregnancy per couple (unexplained and mixed causes).
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Figure 5

Forest plot of comparison: 1 IUI vs FSP: unexplained or mixed (non‐tubal) causes, outcome: 1.2 Clinical pregnancy per couple (unexplained and mixed causes).

Funnel plot of comparison: 1 IUI versus FSP, outcome: 1.2 Clinical pregnancy per couple.
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Figure 6

Funnel plot of comparison: 1 IUI versus FSP, outcome: 1.2 Clinical pregnancy per couple.

Comparison 1 IUI versus FSP, Outcome 1 Live birth per couple.
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Analysis 1.1

Comparison 1 IUI versus FSP, Outcome 1 Live birth per couple.

Comparison 1 IUI versus FSP, Outcome 2 Clinical pregnancy per couple.
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Analysis 1.2

Comparison 1 IUI versus FSP, Outcome 2 Clinical pregnancy per couple.

Comparison 1 IUI versus FSP, Outcome 3 Multiple pregnancy.
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Analysis 1.3

Comparison 1 IUI versus FSP, Outcome 3 Multiple pregnancy.

Comparison 1 IUI versus FSP, Outcome 4 Miscarriage rate.
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Analysis 1.4

Comparison 1 IUI versus FSP, Outcome 4 Miscarriage rate.

Comparison 1 IUI versus FSP, Outcome 5 Ectopic pregnancy.
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Analysis 1.5

Comparison 1 IUI versus FSP, Outcome 5 Ectopic pregnancy.

Comparison 2 IUI versus FSP subgroups by indication, Outcome 1 Unexplained subfertility.
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Analysis 2.1

Comparison 2 IUI versus FSP subgroups by indication, Outcome 1 Unexplained subfertility.

Comparison 2 IUI versus FSP subgroups by indication, Outcome 2 Mild to moderate male factor subfertility.
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Analysis 2.2

Comparison 2 IUI versus FSP subgroups by indication, Outcome 2 Mild to moderate male factor subfertility.

Summary of findings for the main comparison. IUI compared with FSP for non‐tubal infertility

IUI compared with FSP for non‐tubal infertility

Patient or population: women with non‐tubal infertility
Settings: subfertility clinic
Intervention: intrauterine insemination
Comparison: fallopian tube sperm perfusion

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

FSP

IUI

Live birth per couple

133 per 1000

126 per 1000
(83 to 186)

OR 0.94
(0.59 to 1.49)

633
(3 studies)

⊕⊕⊝⊝
low1,2

Clinical pregnancy per couple

185 per 1000

145 per 1000
(100 to 202)

OR 0.75
(0.49 to 1.12)

1745
(14 studies)

⊕⊕⊝⊝
low3,4

Multiple pregnancy per couple

70 per 1000

55 per 1000
(33 to 91)

OR 0.62
(0.29 to 1.32)

908
(7 studies)

⊕⊕⊝⊝
low2,3

Miscarriage per couple

43 per 1000

46 per 1000
(24 to 84)

OR 1.07
(0.56 to 2.05)

884
(7 studies)

⊕⊕⊝⊝
low2,3

Ectopic pregnancy per couple

10 per 1000

8 per 1000
(2 to 30)

OR 0.88
(0.24 to 3.19)

643
(4 studies)

⊕⊝⊝⊝
very low2,3,5

*The basis for the assumed risk (the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1One of the three studies did not describe method of allocation concealment and 19% of women in this study had mild tubal damage.
2Imprecision: Confidence intervals cross the line of no effect and do not exclude an appreciable benefit or harm.
3Most studies failed to provide adequate details of methods of sequence generation and allocation concealment.
4Unexplained statistical heterogeneity (I2 = 52%).
5Very serious imprecision.

Figures and Tables -
Summary of findings for the main comparison. IUI compared with FSP for non‐tubal infertility
Table 1. Per cycle data

Study

Clinical pregnancy per cycle

IUI

FSP

P value

Fanchin 1995

10/50 (20%)

20/50 (40%)

P < 0.04

Filer 1996

12/59 (20%)

5/47 (11%)

P > 0.05

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Table 1. Per cycle data
Comparison 1. IUI versus FSP

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Live birth per couple Show forest plot

3

633

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.59, 1.49]

2 Clinical pregnancy per couple Show forest plot

14

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

3 Multiple pregnancy Show forest plot

8

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Multiple pregnancy per couple

7

908

Odds Ratio (M‐H, Fixed, 95% CI)

0.62 [0.29, 1.32]

3.2 Sensitivity analysis: multiple pregnancy per pregnancy

8

197

Odds Ratio (M‐H, Fixed, 95% CI)

0.96 [0.44, 2.07]

4 Miscarriage rate Show forest plot

7

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Miscarriage per couple

7

884

Odds Ratio (M‐H, Fixed, 95% CI)

1.07 [0.56, 2.05]

4.2 Miscarriage per pregnancy

7

180

Odds Ratio (M‐H, Fixed, 95% CI)

1.32 [0.63, 2.78]

5 Ectopic pregnancy Show forest plot

4

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Ectopic pregnancy per couple

4

643

Odds Ratio (M‐H, Fixed, 95% CI)

0.88 [0.24, 3.19]

5.2 Ectopic pregnancy per pregnancy

4

111

Odds Ratio (M‐H, Fixed, 95% CI)

1.71 [0.42, 6.88]

Figures and Tables -
Comparison 1. IUI versus FSP
Comparison 2. IUI versus FSP subgroups by indication

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Unexplained subfertility Show forest plot

7

378

Odds Ratio (M‐H, Fixed, 95% CI)

0.63 [0.39, 1.02]

1.1 Clinical pregnancy

7

378

Odds Ratio (M‐H, Fixed, 95% CI)

0.63 [0.39, 1.02]

2 Mild to moderate male factor subfertility Show forest plot

5

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Live birth

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.40 [0.14, 1.14]

2.2 Clinical pregnancy

5

303

Odds Ratio (M‐H, Fixed, 95% CI)

0.53 [0.28, 1.01]

Figures and Tables -
Comparison 2. IUI versus FSP subgroups by indication